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34 Cards in this Set
- Front
- Back
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What is the only organ that does not require insulin to utilize glucose
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brain
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What are the actions of insulin?
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1. moves glucose into muscle and adipose
2. conversion of glucose into glycogen and triglycerides 3. stim hepatic glycogen synthesis 4. inhibits muscle and fat breakdown, decreasing release of FA, glycerol and AA 5. Inhibits glycogenolysis and gluconeogenesis |
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What is the primary organ of glucose homeostasis?
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Liver
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When will parenteral (IV) Regular insulin have peak effect?
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30 min
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If IV access is not available, which route of administration should you choose for fastest onset and most reliable absorption?
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IM>SQ
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How much will 1 unit Reg insulin decrease blood sugar?
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1unit-> decrease 25mg/dl IV
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What is the mechanism of action of Sulfonylureas?
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Increase endogenous insulin secretion
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Name 3 sulfonylureas
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Glyburide, Tolbutamine, Chlorpropamide
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What is the duration of action of Glyburide?
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18-24 hrs
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What is the duration of action of Tolbutamide?
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6-10hrs
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What is the duration of action of Chlorpropamide?
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24-72 hrs
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What are the contraindications to sulfonylureas?
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severe insulin deficiency, concurrent illness, perioperative
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Name a Biguanide
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Metformin
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What is the mechanism of action of Biguanides (metformin)?
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Reduces GI glucose absorption, inhibits production, enhances insuylin sensitivity.
Does NOT stimulate insulin secretion |
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What drug impairs excretion of metformin?
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cimetidine
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What is the plasma half life of metformin?
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6 hrs
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What is the side effect that anesthesai providers should be aware of (of Metformin?)
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lactic acidosis, especially in renal/hepatic failure
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The diabetic patient shows metabolic acidosis and severe hyperglycemia. What is the cause? What is a predisposing factor?
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hyperglycemic ketoacidosis, predisposed by infection
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What electrolyte defieciency may be masked in DKA?
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Total body K+ may be depleted yet serum K+ levels normal
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Why is an RSI indicated for diabetics?
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Autonomic neuropathy causes gastroparesis-considered full stomach
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What drug can be given to prevent aspiration with diabetics?
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metoclopramide (reglan)
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What is the danger of cardiac autonomic neuropathy (with coexisting HTN) in the OR?
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Can lead to hypotension unresponsive to ephedrine-give epinephrine 10mcg IV
Can lead to bradycardia unresponsive to atropine-give epinephrine 10 mcg IV |
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What position is risky for a diabetic with retinopathy?
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Prone
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Why is sit important to give a diabetic an antacid pre-op?
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30ml of gastric contents with pH< 2.5 is sufficient to cause chemical pneumonitis if aspirated. cimetidine is very effective
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What period of time in the OR is the diabetic at greatest risk of CV instability due to autonomic neuropathy?
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between intubation and incision-period of no stimulation
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How can airway difficultly be assessed in diabetics
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1. prayer sign-inability to approximate palms D/T stiff joint syndrome
2. Limited atlanto -occippital joint motion 3. limited TMJ motion |
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When should oral hypoglycemic agents be held pre-op?
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AM of surgery (48-72 hrs prior if long acting)
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What test is mandatory for pre-op workup of diabetic?
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EKG-most common peri-operative morbidity in DM is ischemic heart disease
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What is the recommended pre-op blood glucose parameter?
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<200mg/dL
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What is a normal A1C (glycosylated hemoglobin)
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5-7% shows estimated blood glucose control for past 4-6 weeks
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How should pre-op insulin be managed?
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Hold regular insulin AM of surgery, give 1/4 to 1/2 dose NPH; alternatively , hold all insulin and check blood sugar
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What are the intra -op sx of hypoglycemia?
What is the BS level where you will treat? |
tachycardia, sweating, HTN, cold clammy skin
50 mg/dL |
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How is hypoglycemia treated intra-op?
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To raise BS 30mg/dL, give 15 ml D50(=to 7.5 Gm)
Bolus with D50 followed by D10 gtt and insulin gtt to prevent rollercoaster |
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How does DKA lead to acidosis?
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DKA begins with hyperglycemia, leads to osmotic diuresis, dehydration, and acidosis
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